Current Treatment of Multidrug Resistant and Rifampicin Resistant Tuberculosis

Multidrug-and rifampicin-resistant tuberculosis (MDR-TB/RR-TB) has been an area of growing concern to human health worldwide and posing a threat to the control of tuberculosis (TB). Proper treatment of every diagnosed case of MDR-TB/RR-TB is of paramount importance. For the treatment of MDR-TB/RR-TB, standardised, empirical and individualised approaches have been laid down. There can be two types of treatment regimen -conventional and shorter regimen. A conventional regimen of at least five effective anti-TB drugs (ATDs) during the intensive phase is recommended, including pyrazinamide and four core second-line ATDs. Intensive phase including injectables should be given for atleast eight months. The total duration of the treatment is atleast 20 months which can be prolonged upto 24 months depending upon the response of the patient. Shorter regimen for the treatment for subset of MDR-TB/RR-TB patients who have not been previously treated with secondline drugs and in whom resistance to flouroquinolones and second-line injectable agents has been excluded can given for 9-11 months. The intensive phase of 4 to 6 months consists of kanamycin, high dose moxifloxacin, ethionamide, clofazimine, pyrazinamide, high-dose isoniazid and ethambutol, followed by the continuation phase of five months that consist of high dose moxifloxacin clofazimine, pyrazinamide and ethambutol. Extra-pulmonary MDR-TB/RR-TB including TB meningitis is treated with a longer regimen with same duration as pulmonary MDR-TB/RR-TB. All patients initiated on treatment and their family members should be intensively counselled prior to the treatment initiation and during all the follow-up visits. Surgery may be considered with recommended MDR-TB/RR-TB regimen only with good surgical facilities, trained and experienced surgeons and with careful selection of the patients. The treatment outcomes varied from 50% to 80% in different studies.